Full employer posting
Are you passionate about helping patients navigate the healthcare system while ensuring timely access to care and accurate reimbursement? The Richland Hospital & Clinics is seeking a detail-oriented and customer-focused Prior Authorization Specialist / Insurance Specialist to join our Revenue Cycle team. In this role, you will serve as a critical link between patients, providers, insurance companies, and the billing team.
You will be responsible for obtaining and managing prior authorizations, resolving authorization and insurance denials, and supporting billing operations to ensure patients receive the services they need without unnecessary delays.
Prior Authorization Responsibilities Monitor authorization worklists and department schedules to identify services requiring prior authorization. Obtain prior authorizations by submitting required documentation and ensuring compliance with payer requirements. Research, track, and resolve prior authorization denials.
Coordinate appeals, reconsiderations, and peer-to-peer reviews when necessary. Communicate authorization approvals, pendings, and denials to appropriate departments using Expanse and other communication tools. Collaborate closely with providers, schedulers, clinical staff, and revenue cycle teams to prevent delays in patient care.
Maintain accurate documentation of authorization activity and payer communications. Stay current on payer policies, authorization guidelines, and regulatory requirements. Insurance Specialist Responsibilities Perform daily insurance and billing operations.
Review patient accounts to identify and resolve claim denials. Assist with insurance claim resolution activities to support timely reimbursement. Verify insurance benefits and coverage related to requested services.
Conduct payer communications to resolve complex reimbursement issues. Maintain HIPAA compliance and adhere to all applicable federal and state regulations. What We're Looking For
Associate degree in Business Administration, Medical Billing, Health Information Management, Accounting, or a related field. Relevant healthcare revenue cycle, prior authorization, medical billing, or insurance experience may be substituted for formal education. Knowledge of medical terminology, insurance plans, payer guidelines, and reimbursement processes.
Strong analytical, problem-solving, and organizational skills. Excellent written and verbal communication abilities. Experience working within electronic health records and healthcare information systems preferred.
Ability to manage multiple priorities while maintaining accuracy and attention to detail.
The Richland Hospital? At The Richland Hospital, our actions are guided by our 7 C's of Culture : Customer Service – We meet and exceed the expectations of patients, visitors, and staff. Communication – Open and positive communication creates a safe, high-quality environment.
Commitment – We fulfill our mission of being the first choice for better health. Compassion – Every life has value and deserves respect and empathy. Competence – We strive for excellence, innovation, and continuous improvement.
Civility – We treat others with dignity, respect, and professionalism. Community – We prioritize the health and wellness needs of those we serve. Join Our Team If you enjoy solving problems, working collaboratively, and making a direct impact on patient care and organizational success, we encourage you to apply.
Become part of a team committed to delivering exceptional healthcare while supporting our community's health and well-being. The Richland Hospital & Clinics is an Equal Opportunity Employer.
About the role
In this role, you will serve as a critical link between patients, providers, insurance companies, and the billing team. You will be responsible for obtaining and managing prior authorizations, resolving authorization and insurance denials, and supporting billing operations to ensure patients receive the services they need without unnecessary delays.